Tinnitus

What is tinnitus

Tinnitus is characterised by constant ringing, buzzing or other sound that can be heard in a person’s ears, that no-one else can hear.

The noise that is heard can be either soft or loud and can be of any type of noise.

Tinnitus is often worse at night, because that is when there are no other competing noises (television, other people, street noises, animals). People most often notice the tinnitus at night, when they are in bed.

Facts about tinnitus

• Tinnitus may affect about 20% of the population at any given time
• Tinnitus is a very common condition but is temporary in most situations
• Most people may experience mild tinnitus symptoms on occasion, which normally go away
• People with more severe tinnitus may have difficulty sleeping and concentrating properly
• Certain mineral deficiencies may be associated with the development of tinnitus
• Labyrinthitis that is of an allergic nature can develop into tinnitus
• Tinnitus can be due to a number of factors
• The exact cause of tinnitus is not known

Symptoms of tinnitus

There are a multitude of noise symptoms for tinnitus and not everyone hears the same noise:

• Blowing
• Buzzing
• Hissing
• Humming
• Ringing
• Roaring
• Whistling
• Whooshing

The strength of the tinnitus can be either loud or soft, or anywhere in between and the noise levels can vary from day to day.

Some people even hear really unusual noises, such as:

• Air escaping from their ear
• A sound akin to listening to the inside of a seashell
• Musical notes
• Water running

Causes of tinnitus

The exact cause of tinnitus is not known, but there are a number of theories about the underlying factors that may precipitate it:

Alcohol

Alcohol can cause a variety of “ringing in the ears”, tinnitus symptoms, especially at night after drinking the alcohol.

Caffeine

Caffeine (coffee, tea, chocolate, energy drinks) can cause a variety of “ringing in the ears”, tinnitus symptoms, especially at night after eating/drinking the caffeine containing foods/drinks.

Ear wax

An excessive amount of ear wax in the ear can also be responsible for causing “ringing in the ears” and other symptoms of tinnitus.

Medications

There are a number of medications which are thought to cause the “ringing in the ears” symptoms of tinnitus. The most common medications to do this are: antibiotics, aspirin and non-steroidal anti-inflammatory (NSAIDs) medications, but any other medications may also cause the same tinnitus symptoms. In addition to this, salicylate foods (ie tomatoes and foods with artificial additives) can also cause tinnitus symptoms.

Nutritional deficiency

Some experts believe that there are a number of nutritional deficiencies that can precipitate tinnitus symptoms or make them much worse. A deficiency in the following are the nutrients most commonly thought to be responsible: folic acid (folate), manganese, vitamin B12 (cyanocobalamin) and zinc.

Prolonged exposure to loud noise

Any exposure to any type of loud noises for prolonged periods of time can cause tinnitus symptoms. The loud noises most commonly responsible for tinnitus from this cause are: construction noise, drilling and loud music.

Smoking

Cigarette smoking and also prolonged exposure to second hand smoke can both precipitate tinnitus symptoms and cause worsening of symptoms in existing condition.

Viral infection

Any type of viral infection of the ear (particularly labyrinthitis) can cause tinnitus symptoms. Allergic labyrinthitis (an allergic inflammation of the middle ear) can present as tinnitus and unless the allergens are avoided it can continue unabated.

Prevention of tinnitus

Non-preventable risk factors

Tinnitus may be unpreventable in certain circumstances:

• Allergies – studies show that some people who have allergies to certain substances (mould, fungus, pollen, chemicals) may develop tinnitus from the allergy. This cause of tinnitus is difficult to prevent, but can be managed more effectively by avoiding exposure to the allergens and preventing an allergic reaction from precipitating the tinnitus
• Folic acid deficiency – studies show that folic acid deficiency is particularly associated with the development of tinnitus
• Viral infection – any type of upper respiratory viral infection, but especially those which affect the ear (such as labyrinthitis, lyme disease) have the potential to cause tinnitus and this is difficult to prevent. Always strengthen the immune system to avoid complications of any type of viral infection
• Vitamin B12 deficiency – some studies have shown that a vitamin B12 deficiency is particularly associated with the development of tinnitus
• Zinc deficiency – studies show that zinc deficiency is particularly associated with the development of tinnitus, especially in the elderly

Preventable risk factors

There are ways to prevent tinnitus from occurring or at least preventing symptoms from worsening:

• Don’t listen to really loud music – close proximity to very loud music is a known risk factor for the development of tinnitus, so people who listen to music on a hand-held instrument should try to listen to it on lower levels or risk developing tinnitus (and maybe even deafness)
• Don’t smoke – people who smoke have much worse symptoms due to the detrimental effects cigarette smoke has on the blood vessels in the ears. People who do not smoke should also stay away from second hand smoke to prevent worsening of symptoms
• Healthy diet – there are a number of nutritional deficiencies which are associated with the development of tinnitus, particularly folic acid, vitamin B12 and zinc. To prevent this, always eat healthy, unprocessed foods as the mainstay of the diet, with plenty of vegetables, fruit, whole grains, legumes, healthy fats and lean protein
• Keep blood pressure normal – higher than normal blood pressure is a known factor which increases not only risk for tinnitus, but also worse symptoms from the condition. People with high blood pressure must use medication or alternative therapies to reduce their blood pressure so that it is normal

Complications of tinnitus

There are a number of possible complications of tinnitus:

• Hearing loss – prolonged and untreated tinnitus can possibly result in hearing loss, due to the damage that the cause of the tinnitus has on the ear. Exposure to loud noises, for example, if prolonged can result in some hearing loss over time, especially if the exposure has been prolonged and the noise levels have been exceedingly high. In the same way, viral infections other causes of tinnitus can also possibly cause hearing loss if left untreated
• Tumour – a tumour is a growth that can be either benign (harmless) or malignant (deadly). While tinnitus may not be responsible for causing the tumour, the underlying causes of tinnitus could be the catalyst that causes the tumour growth in the first place. A tumour is more likely to be present in people with persistent and severe tinnitus symptoms, or in symptoms that consistently get worse

When to see a doctor about tinnitus

People who have any of the symptoms of tinnitis need to make an appointment to see their doctor who can diagnose this condition (or rule it out) and prescribe appropriate treatment to relieve symptoms.

People who have been diagnosed with tinnitus need to see their doctor if:

• Their symptoms suddenly get worse and none of the medications or other strategies to alleviate symptoms are effective
• They experience different symptoms to the ones they normally experience

Diagnosis of tinnitus

Tinnitus is initially diagnosed through the following tests:

• Medical history of symptoms – the doctor will ask a series of questions about your symptoms (especially the duration and severity), your family medical history (if anyone else has similar symptoms) and some questions about whether you smoke or have any other risk factors associated with this condition
• Physical examination – the ear will be examined by the doctor to determine if there is any obvious swelling or other symptoms of infection

Other tests

If the initial tests are not conclusive, or if symptoms are quite severe, then further tests will be requested:

• Hearing test – a hearing test may be performed to determine if there is any hearing loss and whether it is temporary or permanent
• Diagnostic imaging tests – imaging tests such as MRI and CAT scans can be performed to get an image of the middle ear. These tests provide a more detailed view of the inner ear and will show if there is any damage or inflammation to the ear
• Referrals – if symptoms do not resolve, a referral is given to an ear, nose and throat (ENT) specialist who can perform further testing

Conventional treatment of tinnitus

Conventional treatment of tinnitus depends on the underlying cause of the condition:

Alcohol, caffeine, medications

• Avoid – it is imperative to avoid any form of caffeine (coffee, tea, chocolate, energy drinks), alcohol and certain medications (antibiotics, aspirin, NSAIDs) when tinnitus symptoms are present. Your doctor should be informed if you experience tinnitus symptoms when taking any type of antibiotics

Ear wax

• Clear the ears – if it is determined that a build-up of ear wax is causing the tinnitus symptoms, then the doctor will recommend the ear be cleaned out with a saline solution. Your family doctor can do this simple procedure as can an ear specialist

Loud noises

• Avoid – if the cause of the tinnitus is exposure to loud noises, the treatment is to avoid exposure, or if this is not practical, to use ear plugs which can reduce the level of the noise to a lesser degree. People who listen to loud music on iPods need to turn the volume down to a lower level

Nutritional Deficiency

• Supplements – if a nutritional deficiency is suspected and your doctor determines that that is the cause of the tinnitus, a blood test will be requested. The results of the blood test will determine treatment option – usually supplements recommended by your doctor

Smoking

• Avoid – it is really important to avoid exposure to any type of cigarette smoke, even second hand smoke from other people smoking. People who smoke cigarettes will be recommended to give it up

Viral infection

• Healthy diet – lots of unprocessed fresh foods in the diet to help increase the body’s ability to fight off the infection
• Rest – it is really important to allow the body to fight off any type of viral infection by resting, as this allows the body to use most of its energy in the fight against the virus without having to divert energy to other bodily processes. People who rest generally recover more quickly from any type of viral infection than those who “soldier on”

Alternative / complementary treatment of tinnitus

There are a number of alternative / complementary therapy options in the treatment of tinnitus, which aim to treat the underlying cause of the condition and strengthen the immune system. People with tinnitus need to check with their doctor before trying any of the therapies recommended.

Herbs

There are a number of herbs which may help to reduce the symptoms of tinnitus by improving the underlying cause:

• Echinacea – the herb echinacea has potent anti-viral properties which may assist with healing tinnitus that is due to a viral infection of the ear or other part of the upper respiratory system
• Ginkgo biloba – studies show the herb ginkgo biloba may help to increase blood circulation, including to the ear and may help to reduce symptoms (but one recent study has claimed that there is no benefit)
• Olive leaf – studies show that the herb olive leaf has potent anti-viral properties which may assist with healing tinnitus that is due to a viral infection of the ear or other part of the upper respiratory system

Vitamins

There are a number of vitamins which may help to reduce the symptoms of tinnitus by improving the underlying cause:

• Bioflavonoids – studies show that the bioflavonoids, together with vitamin C, have potent antioxidant properties that help with healing
• Folic acid – studies show that a deficiency in folic acid (folate) can be responsible in causing tinnitus symptoms in some people so supplementation may be necessary once blood tests have confirmed a deficiency exists
• Vitamin A – studies show that the antioxidant vitamin A provides a boost to the immune system to fight off a viral or bacterial infection and it also may help to reduce inflammation in the middle ear, by ensuring all mucous membranes are healthy
• Vitamin B12 – studies show that a deficiency in vitamin B12 (cyanocobalamin) can be responsible in causing tinnitus symptoms in some people so supplementation may be necessary once blood tests have confirmed a deficiency exists
• Vitamin C – studies show that vitamin C, together with bioflavonoids have potent antioxidant properties that help with healing
• Vitamin E – studies show the antioxidant vitamin E helps to enable healing to happen more quickly which helps to reduce symptoms overall

Minerals

There are a number of minerals which may help to reduce the symptoms of tinnitus by improving the underlying cause:

• Magnesium – the mineral magnesium relaxes all of the tissues in the body, especially the smooth tissues, so may help with feelings of stress and anxiety associated with long-term symptoms. In addition to this, studies show that magnesium therapy is very effective in preventing hearing loss and healing it if it occurs (within a specific timeframe)
• Manganese – studies show that a deficiency in manganese can be responsible in causing tinnitus symptoms in some people so supplementation may be necessary once blood tests have confirmed a deficiency exists
• Selenium – studies show the antioxidant mineral selenium helps to boost the immune system during a viral infection and this may reduce the severity and duration of symptoms
• Zinc – a deficiency in zinc may be responsible in causing tinnitus symptoms in some people, so supplementation may be necessary once blood tests have confirmed a deficiency exists. Studies also show the antioxidant mineral zinc, may help the body heal more quickly from any type of viral infection

Other nutrients

There are a number of other nutrients which may help to reduce the symptoms of tinnitus by improving the underlying cause:

• Alpha lipoic acid – studies show that alpha-lipoic acid has potent antioxidant properties that boost the function of the immune system. Alpha-lipoic acid can help to reduce the severity of symptoms, especially when the tinnitus is caused by any type of viral infection
• Coenzyme Q10– a recent study showed when people with chronic tinnitus were supplemented with coenzyme Q10 (especially if there blood levels were low), had improvement in their symptoms during the trial (while they were underoing supplementation with coenzyme Q10). This is the first study of this type and more will be needed to confirm these results
• Garlic – studies show that the herb garlic has potent anti-viral, anti-bacterial properties and may assist with healing more quickly and reducing the symptoms of tinnitus, especially when it is caused (or initiated) by a viral or bacterial infection
• Omega 3 fatty acids – studies show that omega-3 essential fatty acids can assist people who have lots of ear wax in their ears, that could be causing the tinnitus symptoms. In addition to this, omega-3 fatty acids can help to reduce any type of inflammation in the ear

Dietary modifications

There are a number of dietary modifications which may help to reduce the symptoms of tinnitus by improving the underlying cause:

• Avoid alcohol – heavy drinking is a risk factor for developing tinnitus, so limiting alcohol is advisable
• Eat more vegetables – eating adequate amounts of vegetables every day will provide the nutrients necessary to help the body to heal. Especially beneficial are the dark green leafy vegetables, which are dense in nutrients
• Limit processed foods – it is really important to reduce intake of processed foods, as they can cause a burden on the body to try to digest them and get rid of the toxins they produce. Besides this, processed foods have little nutritional value, so do not provide any functional benefits

Lifestyle modifications

There are a number of lifestyle modifications which may help to reduce the symptoms of tinnitus by improving the underlying cause:

• Don’t smoke – cigarette smoking will only exacerbate symptoms, so don’t smoke and avoid other people’s second hand smoke
• More fluids – drink more water, juice and herbal teas to help hydrate the middle ear and help it heal more quickly
• Rest – enabling the body to rest, by lying down and doing very little, will give the body the best chance to heal itself if a viral infection has caused the tinnitus

Alternative treatments

• Acupuncture – several studies show that acupuncture may be used to help treat the underlying cause of the tinnitus and reduce symptomes. Always seek a qualified and recommended therapist

Always ensure that you notify your medical practitioner of any supplements that you want to take – it may interfere with other medication or conditions you have. Confirm with your doctor it is safe to take before you try it.

Living with tinnitus

Self care strategies

There are a number of strategies which are recommended to help deal with tinnitus:

• Avoid alcohol – heavy drinking is a risk factor for developing tinnitus, so limiting alcohol is advisable
• Avoid caffeine – caffeine intake is another risk factor for developing tinnitus, so limit caffeine intake is advisable. Caffeine exists in: coffee, tea, chocolate, energy drinks and some soft drinks
• Avoid tonic water – check the ingredients on any tonic water (or other aerated spring waters) to ensure there is no quinine, as quinine can increase the risk of developing tinnitus
• Don’t smoke – cigarette smoking will only exacerbate your tinnitus symptoms, so don’t smoke and avoid exposure to other people’s second hand cigarette smoke
• Healthy diet – a deficiency in a number of nutrients is thought to cause some forms of tinnitus, so ensure you and your family are eating mainly unprocessed foods, with plenty of fresh vegetables and fruit, legumes, nuts, seeds, unsaturated fats, wholegrains and lean protein. If your have had a blood test to determine deficiency in any nutrients, your doctor will possibly recommend supplements and a diet rich in the foods highest in the particular nutrient
• More fluids – you need to increase your intake of water, diluted fresh juices or herbal teas to increase hydration in the body and help it heal more quickly from the underlying reason causing the tinnitus
• More vegetables and fruit – you need to increase your intake of vegetables, especially the leafy dark green ones and the dark purple ones and the brightly coloured fruits, as they are packed with antioxidants and vital nutrients to help the body heal more quickly from the underlying cause of the tinnitus
• Reduce blood pressure – if you have high blood pressure, it may cause tinnitus symptoms, so managing your condition is essential to preventing not just tinnitus symptoms but far worse outcomes. Ensure you eat less salt, less processed foods and more fresh produce
• Supplements – if you have had a blood test that has determined you are deficient in certain nutrients that are known risk factors for tinnitus if there is a deficiency, then your doctor will recommend supplements to increase these nutrients in the body, as well as recommending a diet rich in these nutrients

Caring for someone with tinnitus

Partner

There are a number of useful strategies to help a partner deal with tinnitus:

• Don’t smoke – exposure to second hand cigarette smoke is a factor which causes worsening of tinnitus symptoms in your partner, so if you have to smoke, do so outside. If your partner smokes, encourage them to give up, for the sake of improving their symptoms and improving their health
• Healthy diet – a deficiency in a number of nutrients is thought to cause some forms of tinnitus, so ensure you and your partner are eating mainly unprocessed foods, with plenty of fresh vegetables and fruit, legumes, nuts, seeds, unsaturated fats, wholegrains and lean protein. If your partner has had a blood test to determine deficiency in any nutrients, your doctor will possibly recommend supplements and a diet rich in the foods highest in the particular nutrient
• No alcohol – try to encourage your partner to drink less alcohol, as it will only exacerbate their symptoms. Try to have less alcohol in the house as it removes temptation
• Reduce exposure to loud noises – keep the television and radio volume levels down lower as more noise exposure can exacerbate symptoms. This is especially pertinent if the tinnitus your partner suffers from is due to prolonged exposure to loud noises

Friends

There are a number of useful strategies to help a friend deal with tinnitus:

• Don’t smoke – exposure to second hand cigarette smoke is a factor which causes worsening of tinnitus symptoms in your friend, so if you have to smoke, do so away from your friend. If your friend smokes, encourage them to give up, for the sake of improving their symptoms and improving their health
• No alcohol – ensure your meetings with your friend do not involve alcohol, as the alcohol can exacerbate their symptoms. Encourage your friend to drink less alcohol

Parents

There are a number of useful strategies to help a child deal with tinnitus:

• Don’t smoke – exposure to second hand cigarette smoke is a factor which causes worsening of tinnitus symptoms in your child, so if you have to smoke, do so outside. If your child smokes, encourage them to give up, for the sake of improving their symptoms and improving their health
• Healthy diet – a deficiency in a number of nutrients is thought to cause some forms of tinnitus, so ensure you and your family are eating mainly unprocessed foods, with plenty of fresh vegetables and fruit, legumes, nuts, seeds, unsaturated fats, wholegrains and lean protein. If your partner has had a blood test to determine deficiency in any nutrients, your doctor will possibly recommend supplements and a diet rich in the foods highest in the particular nutrient
• Reduce exposure to loud noises – keep the television and radio volume levels down lower as more noise exposure can exacerbate symptoms. This is especially pertinent if the tinnitus your child suffers from is due to prolonged exposure to loud noises. Encourage your child to listen to the music in their iPods with the volume lowered

References

• Dalrymple SN, Lewis SH, Philman S. Tinnitus: Diagnosis and Management. National Library of Medicine. 1 June 2021
• Dawes P, Cruickshanks KJ, Marsden A, Moore DR, Munro KJ. Relationship between Diet, Tinnitus, and Hearing Difficulties. National Library of Medicine. 24 February 2020
• Engelke M, Simões JP, Basso L, Wunder N, Langguth B, Probst T, Pryss R, Schlee W. Understanding tinnitus symptom dynamics and clinical improvement through intensive longitudinal data. Nature. 14 January 2025
• Enrico P, Sirca D, Mereu M. Antioxidants, minerals, vitamins, and herbal remedies in tinnitus therapy. National Library of Medicine. 2007
• Grossan M, Peterson DC. Tinnitus, StatPearls. National Library of Medicine. 20 March 2023
• Henry JA, Reavis KM, Griest SE, Thielman EJ, Theodoroff SM, Grush LD, Carlson KF. Tinnitus: An Epidemiological Perspective. National Library of Medicine. 30 August 2020
• Hofmeister M. Do dietary factors significantly influence tinnitus? Australian Journal of General Practice. Volume 48, issue 3, March 2019
• Lee HY, Jung DJ. Recent Updates on Tinnitus Management. National Library of Medicine. October 2023
• Leutzenberg F, Babu S, Seidman MD. Alternative Treatments of Tinnitus: Alternative Medicine. National Library of Medicine. August 2020
• Lin CH, K CE, Y HC, Lai YK, Huang YC, Tsai MY. Efficacy of adjuvant Chinese herbal formula treatment for chronic tinnitus: A retrospective observational study. Science Direct. Complementary Therapies in Medicine. Volume 23, Issue 2, April 2015, Pages 226-232
• Liu D, Hu Y, Wang D, Han H, Wang Y, Wang X, Zhou Z, Ma X, Dong Y. Herbal Medicines in the treatment of tinnitus: An updated review. National Library of Medicine. 4 January 2023
• Osiecki H. The Physicans Handbook of Clinical Nutrition, 6th Edition. Bioconcepts Publishing QLD, 2006
• Sereda M, Xia J, Scutt P, Hilton MP, El Refaie A, Hoare DJ. Ginkgo biloba for tinnitus. National Library of Medicine. 16 November 2022
• Tang D, Hauwei L, Chen L. Advances in Understanding, Diagnosis, and Treatment of Tinnitus. National Library of Medicine. 2019

Last reviewed and updated: 8 May 2025